This is going to follow on from my PSA. http://www.scribd.

com/doc/142382507/PSA-Talk-toYour-Doctor There is some 'scientific evidence' to quote but in order to get a balanced view I will need to draw on other sources. If anyone can point me in the right direction or would like to comment - that would be most appreciated. ************* As a health scientist, Im interested in creating a blog post for a hospital website or a short article to be published in a health/popular science magazine that seeks to persuade an audience of people with chronic medical conditions and medical professionals that non-adherence to treatment is an issue related to the nature of the consultation relationship between patient and doctor. The aim of the piece will be to encourage patients and medical advisors to explore reasons why communication may be difficult in their situation and to create an empowered situation for the patient where a strong mutual trust relationship can be formed that will open and honest exchange of information.

Stasis: Facts /conjecture People have health issues and can die because they dont take their medication as prescribed by their medical advisor. Facts: It has been established in the medical literature that a large percentage of people dont take their medications as prescribed by their physicians. This results in medical complications that can lead to ill health and even death. Facts: It is less easy to show that people might benefit from not taking their medication. There are occasionally reports in the newspapers of people getting adverse reactions, prescribed the wrong medications etc. These contribute to the reasons why people to not take prescribed medication. This side of the argument tends to rely on reported experiences which may not feel as if it has equal value to the 'evidence' from the scientific literature. Statistics from emergency hospitals indicate that non-compliance is a big problem. There are many possible causes for the problem: the one that I support is that people dont trust their physicians and that people have agendas which are personal and not revealed to their doctors.There is also some evidence that chronic patients have multiple doctors and multiple treatment options. So, if they don't comply with one treatment then they may be complying with another. Has the problem changed recently: It has probably always been with us but perhaps increased with greater access to medical information via the internet and access to patient experience descriptions on blogs etc.. Prior to the internet this was more difficult. People are more aware of alternative treatment options and the potential side effects of some medications. Our society has probably always had a general distrust in science which probably fluctuates over time and may be different in different countries/cultures. There are a number of scientific sources available for evidence eg. there is a British Medical Journal article on this issue, there are also newspaper articles, conference presentations etc. Although there is evidence available it is not an issue that has received a great deal of attention. Reliability: some peer reviewed articles and some non-reviewed sources are available. Definition The nature of the problem is generally of trust. The lack of communication has roots in both the nature of the medical consultation and in personal relationships with authority. The medical profession is trained to treat

symptoms and not people. People are not used to being open with others when they are unsure of their motives and there is the possibility to be judged by the other who is of a superior level. When this happens people are not completely honest about their medical condition and about their compliance with the treatment. What underlays the problem is probably that there is that the patient is in a secondary position to the doctor and this misbalance of empowerment does not encourage openness. Therefore the problem is to do with: disempowerment. What elements of the problem can be identified: consultation process, trust, resource limitations (eg. time), shame, honour, power relationships, access to several health professionals without knowledge of each other, psychological need to feel independent, doctors acting paternally, nature of the historical relationship and reluctance to change, Relationship of the parts: both sides of the equation have barriers to open and honest relationships, these barriers are often hidden, unspoken and may be sub-conscious. Who is influencing the definition: There is a move towards empowerment in society that is being put forward by patient groups and social sciences. The definition of empowerment and patient centeredness are vague and leads to different groups defining the issues in different ways which can appear that the definitions serve different stakeholders. Quality - The seriousness of the issue. This is a serious issue which affects peoples lives. It could be a relatively easy problem to solve if people were willing to accept that it is a problem. A the present time it is a serious problem which is underestimated by the medical profession Stakeholders include: patients, doctors, health insurance, families There is an opposite statistic which is not available and that is how many people survived and got better because they did not take the medication as prescribed. This opposite argument will also have to be investigated but there is likely to be even less information and evidence on this. Possible costs associated with the issue: there is the cost to human suffering and life if people do not take the medication as prescribed. On a more direct financial cost level there is one argument which is often given against patient centeredness and empowerment is that it will result in more time in consultation and the identification of patient needs that cannot be satisfied within the current resource allocations. Opposition to this argument has been given that consultation time is initially increased but that complications are reduced and therefor time with the patient is ultimately saved in the long-term. Who influences the seriousness of the problem: This is a problem where there are few people challenging the cause. So, that at the moment inertia predicts that the seriousness of the problem is not recognised and not discussed. Why arent things being done: an argument could be that the medical profession is in denial generally doctors do not believe that their patients are not taking the medication that they prescribe (this depends on the medication and type of treatment / side effects). Therefore, there is a lack of motivation from the medical side to treat the issue with the seriousness that I think it deserves. On the patient side, patients are seldom well enough organised that issues of empowerment are even discussed. Policy - relevance - plan of action. Action should be taken now. Action should be taken by the medical profession, patient organisations, patients, government health-policy makers. What should be done: increase information about the problem, doctor and patient training; establish a new vision for medical consultations which incorporates empowerment issues. What needs to happen: there needs to be a debate on this issue; there needs to be greater understanding of the causes; there is a need for training of medical professionals.

However, the problem shouldnt be exaggerated in most cases people do take their medication as prescribed but for those who do not there needs to be a way to identify their issues and create a consultation process where they can be open and honest Who should be influenced: the medical profession, general approach of society to medical consultations, patients.